Provider Demographics
NPI:1194028712
Name:CENTURY GRAND INC
Entity Type:Organization
Organization Name:CENTURY GRAND INC
Other - Org Name:26 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YANYU
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-925-3838
Mailing Address - Street 1:26 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6817
Mailing Address - Country:US
Mailing Address - Phone:212-925-3838
Mailing Address - Fax:212-925-3833
Practice Address - Street 1:26 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6817
Practice Address - Country:US
Practice Address - Phone:212-925-3838
Practice Address - Fax:212-925-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NY3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5801748OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY03318678Medicaid
5801748OtherNCPDP PROVIDER IDENTIFICATION NUMBER